· Define what is meant by “opioid tolerant,” including the FDA’s definition and both legitimate and illicit use of opioids.
· Describe pain management options for patients receiving opioid agonist therapy for a history of substance abuse (eg, buprenorphine or methadone).
· List two ways patients with substance dependence or abuse in the palliative care setting may be clinically different from those without these issues.
Substance abuse and physical dependence are prevalent in the United States. According to the National Institute on Drug Abuse, in 2012, 17.7 million Americans (6.8% of the population) had dependence on or abuse of alcohol, 4.3 million met criteria for marijuana, and 2.1 million for prescription pain...
Substance abuse and physical dependence are prevalent in the United States. According to the National Institute on Drug Abuse, in 2012, 17.7 million Americans (6.8% of the population) had dependence on or abuse of alcohol, 4.3 million met criteria for marijuana, and 2.1 million for prescription pain medication. The number of people older than 50 years with these issues is steadily rising. This population has a higher likelihood of facing serious illness while also battling substance dependence or abuse. As a result, their prevalence in the palliative care setting is expected to increase significantly. Medications are commonly used to treat or control addiction. Some of these may be unfamiliar to palliative care practitioners or are used in ways that are unique to addiction therapy. In addition, some of the medications commonly used in symptom management may need to be avoided, adjusted, or more closely monitored when prescribed to those with substance dependence or abuse issues. Participants will learn the definition of “opioid tolerant” and will be able to provide several examples, including both legitimate and illicit opioid use. We will review the medications more commonly used to treat or control addiction, describe how they may need to be adjusted in the palliative care setting for safety or for symptom management, and discuss the appropriateness of discontinuing them when receiving hospice care. We will also review some of the unique clinical challenges common in symptom management in those with active or past substance dependence or abuse issues. This presentation will have a strong practical emphasis for immediate application in clinical practice.